You and your group are on the wilderness adventure of a lifetime, far from civilization, surrounded by wilderness. Someone gets hurt or sick. What do you do? Before you leave on your camping, backpacking, canoeing, or climbing wilderness adventure, learn how to administer wilderness first aid, and know what constitutes a good first aid kit.
How to survey, assess, and stabilize the victim and the medical situation
What questions to ask to gain necessary vital information
How to manage physical symptoms as well as care for wounds or orthopedic injuries
Know the items required within an innovative medical kit, understanding when to use and how to dispense the contents appropriately
- William W. Forgey M.D.
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Laceration of the wrist,
where direct pressure was used
to stop the bleeding.
Permission of use, Buck Tilton.
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NEWEST EDITION With Dr. William Forgey's comprehensive Wilderness Medicine, 6th: Beyond First Aid in hand, you can recognize, assess, and treat many kinds of medical emergencies. This fully revised and updated, illustrated text is essential reading for anyone from trip leaders, guides, and search and rescue groups to EMTs, paramedics, and physicians who must provide immediate care when access to a medical facility is difficult or impossible. Learn how to survey, assess, and stabilize the victim and the medical situation, what questions to ask to gain necessary vital information, how to manage physical symptoms as well as care for wounds and orthopedic injuries and much more.
With Dr. William Forgey's comprehensive Wilderness Medicine, Beyond First Aid, 5th Edition in hand, you can recognize, assess, and treat many kinds of medical emergencies. He has also assembled several truly innovative medical kits, in which their use is supported thoroughly within this fully illustrated text. This outstanding book is essential reading for anyone - from trip leaders, guides, search and rescue groups to EMT's, paramedics, and physicians - who must provide immediate care when access to a medical facility is difficult or impossible. Dr. Forgey has also written Basic Illustrated Wilderness First Aid (Basic Essentials Series) , a richly illustrated and information packed tool for the novice or handy reference for the veteran, distilling years of knowledge into an affordable and visual guide. For those who spend extended periods of time outdoors in winter conditions, Dr. Forgey has written Basic Essentials Hypothermia, 2nd (Basic Essentials Series) . There are many aspects to medical kits and treatment of afflicted persons when the temperatures drop. This book explains clearly and concisely with appropriate illustration, the needs of persons suffering from cold weather exposure when time is of the essence, and medical care facilities are too far away to be of any assistance for the victim. Another book, Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care, 5th , which was edited by Dr. Forgey, and is another excellent resource for those who head out into the vast wilderness for long periods of time. ______________________________________________________________________________________________________
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The Bleeding Wound - Taken from Dr. William Forgey's Wilderness Medicine, - although not verbatim.
The first aid approach to a bleeding wound in remote areas is to stop the bleeding, and treat for shock. Direct pressure is the best method of stopping bleeding. Remember to keep the wound area as clean as possible, and to avoid as much as possible direct contact with the blood of the victim by the person providing treatment. Clean dressing and nitrile gloves would be ideal, and should be a part of any medical first aid kit. But in a pinch a clean cloth, bandana, article of clothing, even clean soft plastic will work, but stop the bleeding.
The bottom line with shock amounts to inadequate oxygenated blood supply getting to the brain. Lie the patient down, feet elevated above the head, and provide protection from the environment - both the ground and atmosphere. Anything at this point will work, spare clothing, tent, tarp, poncho, or empty backpack. You will need to eventually set up a tent or rain, wind, sun protection for the victim, and place sleeping pads or bags below and over the victim, while others prepare materials for further wound care.
If the direct pressure isn't working at stopping the bleeding, a tourniquet may be required. Be sure a complete understanding of how to use a tourniquet is utilized. Its use should be limited to 5 minute increments, with direct pressure between its uses. This method will reduce the chances for clots to form in the veins. If all else fails, two fingers placed directly into the wound will usually stop the bleeding completely, and can be used anywhere on the body. Remember, not to come into skin contact with the victim's blood if at all possible. If it's not possible, the bleeding still needs to be stopped. Further treatment from here is addressed within Wilderness Medicine, including complete cleaning, closure of the wound, and other special conciderations.
This is a basic good start in dealing with a bleeding wound, and Dr. Forgey completely explains all the necessary details including medical supplies within first aid kits that are required to reliably care for the victim, with a more than satisfactory outcome. It goes without saying, reading the text and understanding the procedures is absolutely essential for a least one - preferably more - team members. This can make the difference between a bump in the road of adventure travel, and a truly catastrophic ending, requiring professional search, rescue, and evacuation, and possibly loss of limb or life.
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Friction blisters where the dead skin over the blister has been removed.
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Blisters - Taken from Dr. William Forgey's Wilderness Medicine, - although not verbatim.
If a friction blister has developed, it will need to be lanced. Cleanse with soap and water or surgical scrub and open along an edge with a sharp (clean) blade. There is no advantage in making a small hole as opposed to a wide incision. Allow the skin covering to collapse by expressing the fluid, and then apply a fully stripped piece of Second Skin.
The substance 2nd skin, an easily obtainable substance has revolutionized the prevention and care of friction blisters. It is available at most athletic supply and drug stores. and should be a part of any first aid kit. Made from an inert, breathable gel consisting of 4%polyethylene oxide and 96% water, it has the feel and consistency of, well, most people would say snot. It comes in various sized sheets, sterile, and sealed in water tight packages.
The 2nd skin is best applied by removing from the package, and removing the cellophane from one side, and then apply it to the wound, covering it completely. Once it adheres to the skin surface, remove the cellophane from the outside edge. Over this you will need to place the adhesive knit that comes with the 2nd skin. The bandage must be kept moist with clean water. The 2nd skin should be replaced daily. If the skin is still covering the wound, it should be removed after 2 days, as the skin underneath is now less raw and the dead skin will start to decompose. This can be done by cutting away the dead skin close to where it interfaces with healthy skin using a sharp (clean) blade.
Until you use it on a friction blister, you'll find it hard to believe how well 2nd skin works, as it is very cool to the touch. It has three valuable properties that make it so useful: it will remove all friction between two moving surfaces (hence it's use in prevention, by applying to the site where friction is creating a hot spot); it cleans and deodorizes wounds by absorbing blood, serum, or pus; and it's cooling effect is very soothing, which aids in pain relief.
Blisters can be prevented if immediate care is taken of any hot spot as soon as it develops. Generally a simple piece of tape placed directly over the hot spot will eliminate any friction causing the problem.
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Frostbite area above the foot that has thawed will develop blisters, avoid opening any blisyers that form.
A black carapace will form in severe frostbite, leave these blackened areas alone.
Cover these area with sertile gauze and protect from refreezing, and treat with care to prevent infection.
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Frostbite - Taken from Dr. William Forgey's Basic Essentials Hypothermia, - although not verbatim.
Frostbite is the freezing of tissue, which can begin when skin temperature is cooled to between 22 deg. F and 24 deg. F (-5.5 deg. C and -4.4 deg. C). A decreased peripheral circulation from vasoconstriction due to hypothermia, or the wearing of constricting garments that reduce blood flow can be important factors in frostbite formation.
Cold weather clothing should be constructed and fitted to avoid constriction of blood flow. Tight clothing bands on ankles and wrists, or tight fitting boots must be avoided. Dehydration, adequate nutrition and prevention of fatigue are additional preventative measures in the fight against frostbite. This is in large measure due to their importance in preventing hypothermia.
Outside temperatures must be below freezing for frostbite to occur. The underlying physical condition of the victim, length of cold contact, and type of cold are other important factors leading to frostbite. Lack of oxygen supply is also a factor. This is much more prevalent in high altitude climbing, as well as the use of vasoconstriction, primarily smoking.
By definition frostbite means that tissue has been not only frozen, but damaged. If the outside temperature is below freezing, and circulation of warm blood has been compromised, the fluid between cells may start to freeze. This freezing process pulls additional fluid from the surrounding cells as the ice crystals grow. While these crystals do not seem to cause tissue damage, the dehydration process results in damage to the cells metabolic systems and structures. This damage can be become severe within half an hour.
Frostbite injuries should be rewarmed as soon as possible upon their discovery. Many frostbite injuries thaw by themselves right in the field. Increased activity may allow a frozen foot to rewarm, with the victim incidentally discovering the discoloration of the thawed tissue when examining a numb foot. Carefully avoid refreezing any tissue that has frozen and thawed, this will cause substantial additional tissue loss. The specific therapy for a deeply frozen extremity is fully explained in Dr. Forgey's book.
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Fangs of venomous snakes only need to puncture the skin to inject venom.
The whole fang does not need to inbed itself under the surface of the skin.
But note the length of these fangs and how they curve back, inducing a latching on function,
allowing the snake more time to inject venom.
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Snakes, their identification and distribution.
Special thanks to Michael Cardwell for providing the illustrations on this page. Mike is a professional photographer and is capable of providing high quality photos of numerous species of plants, animals, and scenery.
Pit vipers are identified by long, folding maxillary fangs and a heat-sensitive pit in each side of the face between the nostril and the eye. All North American pit vipers can be identified by the combination of keeled mid-dorsal scales and undivided sub caudal (under the tail) scales.
Common Poisonous North American Snakes
Mojave rattlesnake (Crotalus scutulatus) found in the Mojave desert basin in the United States - the most venomous snake in North America.
The Eastern Diamondback Rattler (Crotalus adamanteus) - Eastern, Midwest and Southern United States.
Cottonmouth (Agkistrodon piscivorus leucostoma) - Eastern, Midwest and Southern United States.
Copperhead (Agkistrodon c. contortix) - Eastern, Midwest and Southern United States.
Easter Coral Snake (Micrurus fulvius tenere)
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Common Poisonous North American Snakes
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.Mojave rattlesnake (Crotalus scutulatus)
found in the Mojave desert basin in the United States
- the most venomous snake in North America.
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The Eastern Diamondback Rattler (Crotalus adamanteus)
- Eastern, Midwest and Southern United States.
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Cottonmouth (Agkistrodon piscivorus leucostoma)
- Eastern, Midwest and Southern United States.
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Copperhead (Agkistrodon c. contortix)
- Eastern, Midwest and Southern United States.
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.Eastern Coral Snake (Micrurus fulvius tenere)
- Eastern, Midwest and Southern United States.
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North American Spider Bites
Brown Recluse
Marking: Dark brown fiddle shape on the front, top side.
Habitat: Barns, sheds, garages, and other seldom-disturbed dark places. They tend to hide in legs and arms of garments and in beds that have been unoccupied for an extended time.
Bite: A white blister at bite area that may or may not be painful at first. This bite area enlarges and the area becomes inflamed and hard to the touch. Eventually the area blackens, tissue eats away, often quite deeply. A deep ulcerated sore may grow to the size of a half-dollar. Healing may require eight weeks; skin graft may also be needed.
Black Widow
Marking: While the coat is generally glossy black with a red hourglass mark on the abdomen, sometimes the hourglass mark is merely a red dot or the two parts of the hour glass do not connect. At times the coat is not shiny and it may contain white.
Habitat: Very reclusive, it loves the outhouses (underside of the toilet opening), inside pipes or hollow logs.
Bite: It may only be a pin-prick, but generally a dull cramping pain begins within one quarter of an hour and this may spread gradually until it involves the entire body. Muscles may go into spasms and the abdomen becomes board-like. Extreme restlessness is typical and the pain can become excruciating. Nausea, vomiting, swelling of eyelids, weakness, anxiety (naturally), and pain with breathing may all develop. A healthy adult can usually survive. Anti-toxin is available.
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Ticks vary in size between species,
as well as over their lifetime
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Major tick borne diseases in the United States
Lyme disease, Relapsing fever, Rock Mountain Spotted Fever, Ehrlichiosis, Tularemia, Babesiosi, Colorado Tick Fever, Tick Paralysis.
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Other books on Wilderness Medicine and First Aid
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Another outstanding outdoorsman, leader, and author is Buck Tilton, MS, WEMT,. He began camping with his Dad and as a Boy Scout in the southeastern U.S. and has earned his living for more than 25 years in wilderness education and medicine. He is cofounder of the Wilderness Medicine Institute of the National Outdoor Leadership School (NOLS). Currently he serves as executive director of the Wilderness Medicine Institute, Pitkin, CO.
Wilderness First Responder, 3rd: How to Recognize, Treat, and Prevent Emergencies in the Backcountry (Wilderness First Responder: How to Recognize, Treat, &) -- The first teaching manual ever for the "Wilderness First Responder" course, this title represents the cutting edge in medical training for wilderness rescue and self care. The schools affiliated with Tilton's program include the Wilderness Medicine Institute, a subsidiary of NOLS, and SOLO. It is "The award-winning guide to medical training for wilderness rescue and self-care". The book is a comprehensive text for the recognition, treatment, and prevention of backcountry emergencies. This invaluable resource includes expert step-by-step instructions, clear illustrations, and "Signs and Symptoms" sidebars designed to help you provide immediate care in the wilderness. It is essential reading for wilderness educators, trip leaders, guides, search and rescue groups, and anyone who works or plays far from definitive medical care. Learn how to assess and treat: Airway obstructions, Cardiac arrest, External and internal bleeding, Shock, Spine injuries, Head injuries, Chest injuries, Abdominal injuries, Fractures and dislocations, Athletic injuries, Soft-tissue injuries, Cold- or heat-induced injuries, Altitude sickness, Insect bites and stings, Diabetic emergencies, Poisoning emergencies, Allergic reactions and anaphylaxis.
Backcountry First Aid and Extended Care, 5th (Falcon Guide) -- This book provides principles for dealing with many serious emergencies, and a few common problems, when a doctor is more than an hour away.Small enough to take in the field, this pocket-sized survival essential will benefit everyone in a wilderness setting. With information on treating shock victims, abdominal pain, sprains, fractures, dislocations and much more, this is an inexpensive way to save someone's life! .
Knack First Aid: A Complete Illustrated Guide (Knack: Make It easy) -- Someone is injured or sick, and you are the first person there who can help. Whether performing CPR, assessing spine injury, or applying a tourniquet, you need to know exactly what to do. Enter Knack First Aid. With full-color photos and clear, step-by-step instructions throughout, it makes mastering the basics easier than ever.
Buck is the author of several other books as well; Click on the "Camping" page of this site to access some of his other writings.
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